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Tag: Policy/Politics

POLICY/POLITICS: Econ 101

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I’m up at Spot-on taking explaining very basic economics to the unwashed masses in a piece called Back To School, Business Week and no I didn’t get to choose the title. The main point is that health care is not infrastructure nor is it manufacturing. It’s a service industry, like teaching English Lit.  Come back here to comment.


There’s been a lot of fuss in the last week about the BusinessWeek article that suggested that all employment growth in America in the last year had come in the health care sector.
Well that’s not too surprising. The money pouring into health care has
been going up at more than 10% a year since 2000 while the rest of the
economy has been relatively stagnant (at least compared to
historical growth rates). The non-employment sector of the economy
(i.e. corporate profits) has been growing much faster than the labor
sector. Health care, though, is a labor intensive business – you need
those nurses, techs, and even doctors to look after patients. Continue …

POLITICS/POLICY: Shock-Horror–I almost agree with Arnold Kling

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Arnold Kling responds to Moulitas’ (DailyKos) overture to the Libertarians in a piece called Dear Libertarian Democrats… The only slight flaw in all this is that there aren’t very many libertarians, but then again we don’t need too many Republican voters to change sides!

Kling proposes running school choice in a few states and single payer health care in a few states. The only flaw here is in thinking that they’re much different. After all single payer health care in the usual American sense means putting all the money in one social insurance pool and allowing people to choose which doctors and hospitals they go to. As far as I can see school choice in Kling’s version is the same: creating one pool of all K-12 education dollars and letting kids/parents choose the schools they want to go to. In both cases everyone needs to be in the same pool, and the money follows the choice of the individual. I don’t understand how the libertarians can decry one as evil socialism while being OK with the other, unless they really favor repealing universal compulsory education. But maybe they do!

As for the health experiment, it probably depends where they run single payer. But the likelihood is that a really effective single payer plan run across state lines would be a wash. It would attract old school industry (autos) who would get rid of their “obligations” on the state, but it would also attract entrepreneurs suffering from job lock. It might lose jobs from employers with younger than average workforce, but theoretically it’ll be a wash. While single payer may not be the best option for financing health care delivery, and while a universal voucher scheme like educational choice may work too, a compulsory universal single insurance pool is by far the best option.

 

 

POLICY: The New York Times cannot leave its pustilent sore alone!

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This one is absolutely beyond belief. This time the dog is licking its sore raw and just cannot stop. Two boneheaded articles based on Cutler’s work have run in the NY Times in the last few weeks, and required such smacking down that Joe Paduda gave me the headline Matt 1, NY Times 0. Meanwhile the NY times got a boatload of letters criticizing the second of them.

But does that stop them? Oh, no. Today a libertarian blogger who’s a professor from George Mason University, which prior to today was best known for its basketball team’s Cinderalla NCAA run last year, gets given a full column in the nation’s paper of record in which he actually says that the “American health care system may be performing better than it seems” because our scientists win more Nobel Prizes than those foreigners do! And we have more innovation in developing new treatments here! And more so that because we’re spending more money on health compared to those evil European systems that restrain costs, this is, wait for it, “saving lives.” Yup, apparently while it might look sensible to make an effort to restrain health care costs:

In the short run, this would save money but in the longer run it would cost lives.

Oh, and we’re also doing more tests, procedures and visits with specialists because this is what people want!

If we count “giving people what they would want, if they knew it was there” as one measure of medical value, the American system looks better.

If wing nuts like this want to spout complete garbage on their loony-toons blog, well he has a first amendment right to do so. After all, other than 40 years of health technology assessment research on innapropriate use of medical technology, the Dartmouth/Wennberg school showing massive variation in care where more care leads to worse outcomes, and the IOM reports that show 100,000 annual deaths from medical errors largely from inappropriate overuse of technology, and 20,000 annual deaths directly from being uninsured, there’s almost no evidence he’s wrong!

But why the hell is the NY Times deciding that it must launch this last ditch defense of the American health care system? I think we should be told.

Otherwise they should give an entire week over to rational critics of the system, starting with Jack Wennberg.

UPDATE: The Michigan Independent thinks as I do, but is slightly calmer and performs the line by line rebuttal that I just couldn’t bear to do

PHARMA/POLICY: U.S. Drops Program to Halt Discount Drugs From Canada

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U.S. Drops Program to Halt Discount Drugs From Canada

The federal government plans to halt a controversial crackdown on discount drugs mailed from Canadian pharmacies to U.S. customers, removing a significant hurdle to Americans buying cheaper medications from abroad.

So 80% of Seniors support importing Rx from Canada, and the DOJ backs off its crackdown on imports.

Could there just possibly be an election coming up soon? Just possibly, could these two events be related?

POLICY/POLITICS: Personal angst on research

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There are sometimes when two contradictory thought streams start charging through my brain and I can’t cope. This is one.

I got an email from a PR person for this website http://www.yourcandidatesyourhealth.org/ which tells you your local candidates record essentially for or against embryonic stem cell research. As you might guess, the idea from Research!America and the Lasker Foundation is to encourage people to vote against candidates opposing stem cell research (or at least get them to change their mind. The Research!America folks are a cross-section of business and academic types who like medical research.

And honestly how can any rational person be against them? When the choice is between them and the creationists who were only happy when we all lived in the dark ages, and don’t believe in the Enlightenment, personal liberty, the scientific method, et al. (Not of course that they won’t use the technological fruits of the movements they despise, particularly Talk Radio!).

But on the other hand, any really rational assessment of the health care system shows that we are spending way too much on medical research. The NIH alone is $30 billion a year, and that’s about doubled by private industry. Now we’re adding billions more at the state level. The problem is that the application of the products of that research is downright shoddy, and we’re spending almost nothing comparatively to figure out how to make it better.

It would be much better for the country and the health care system if we took the $30 billion spent on the NIH and the $300 million spent on AHRQ and flipped them. Then we’d really figure out how to apply the stuff we already know evenly and appropriately. We just don’t need more me-too cancer drugs at $4,000 a pop, when we can’t figure out how to get an Rx for aspirin in to the hands of discharged cardiac care patients (or whatever the appropriate cheap therapy is).

I’m convinced that if we put a ten year moratorium on all new medical research today, and spent all the money figuring out how to apply—and then actually applying—our medical knowledge across the board, we’d be much better off. Of course that’s never going to happen, and we need to save science from the hands of the anti-Enlightenment Philistines. But I remain to be convinced that the Research!America folks are applying their scientific resources in the most appropriate way possible.

Meanwhile, Steve Parker tells me about the launch of a new site called www.BreastCancerAwareness.com  which is pretty self-explanatory and looks like it’ll be a useful resource.

PHARMA/POLICY/POLITICS: November comes after September

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Interesting article in the WaPo about the impact of the donut hole in Part D on the Senior vote. I think it will matter, it will hurt the Republicans and the signs seems to be point that way in one House race in Florida. Of course whether it will matter enough to push the House over to the Democrats is another matter. But the most interesting stat in the article is buried on the second page.

Perhaps playing in Klein’s benefit: More seniors are finding themselves
in the doughnut hole as the election approaches. The Institute for
America’s Future, a group calling for the closure of the gap,
calculated that, on average, seniors who enrolled in the benefit at the
beginning of the year would have fallen into the doughnut hole on Sept.
22.

So this problem will get worse all the way up to election day, and the greed fest known as the Medicare Modernization Act (of which to be fair the greed of big Pharma was only one small part) may play a factor. And if it does, the obvious change that the Democrats would now put in the bill would be negotiated pricing.

That was not what Pharma wants, but of course it’s a maybe and the CEOs of big Pharma who pushed the bill through are leaving their posts and leaving the potential consequences to their successors. My guess is that those successors will wise up and figure out how to cut a more reasonable deal so that they are not so squarely in the gun sights when the nation has a real debate about health care costs in a few more years.

 

QUALITY/POLICY: Futurist’s forecast from Clem Bezold

Clem Bezold from Institute for Alternative Futures (kind of the alternative IFTF) gave an overview of the conference and an optimistic 2016 forecast for the availability of broadband to the home, better knowledge and personalized tools that will work on that information. Then he gets a little more controversial, including personal values, need for universal coverage, end of life care in context, etc — all as part of care in 2016

His main talk is about accelerating Disparity Reducing Advances project—wants to accelerate the technologies and process that reduce the social disparities in health care. They are not looking at the bigger picture of employment, education, etc, (consciously) and its impact on health, but they think that they can make a difference in the health care provision and tech part. They’re trying to pick their targets. And the first one is:

—Prevent obesity in poor populations. That leads to different levels of action in diff government and social programs. but we need to change the social environment, including getting the right foods into the right neighborhoods, as well as doing the health care screening and pre-diabetes initiatives. So there are a whole variety of factors you;d get to for any diseases, and information therapy is a big part.

Some things they’re trying—working with cell phones (LG has launched a diabetes phone this month which has a built in test strip reader. Also looking at biomonitoring activity, all connected to cell phones infrastructure. But needs to be connected to services. There are proposals to say that spectrum should not be auctioned off, but instead should be free (internet telephony over free wiMax?). That will be all added to patient and care giver “navigation”.

His forecast for monitoring. By 2008 standards for biomonitoring; by 2012 reimbursement has changed so it gets pay for; by 2016 common in us for monitoring the chronically ill and elderly. My feelings that this is about right, but it’ll require a whole hell of a lot of changes in the system…and of course there are huge infrastructure issues for the lower income providers (tech access, language, etc) which Clem spelled out clearly (and far too quickly to note down easily!)

Clem is an “aspirational” futurist who’s trying to change the future as much as explain it. At IFTF we were “analytical” futurists, and we derided the aspirational guys as the “personal helicopters by the year 2000” school of futurist — but his talk was really interesting, and frankly alot of analytical futurism is by definition wrong. So hopefully Clem provoked some big goals that we should all be going after.

I asked him about the norms of advertising for food and obesity—he thinks policy things can be done. And also about the system change required for home monitoring? How can the system change? He thinks that health care will be redesigned the hard way, otherwise it’s a perfect storm. It’ll get worse before it gets better. How do you get the patients and care-givers in the right place within the system. We will re-torque our use of health care providers to make that change.

Josh Seidman put up the Ghandi mantra “First they ignore you, then they laugh at you, then they fight you, then you win.” I think Ix is still being ignored, but soon it’ll be heading to the “fighting” part—and that is when it’ll get brutal.

Meanwhile in a moment of Ghandi zen, here’s a photo of a balloon over the canyons this morning

Photo_092706_001

PHARMA/POLITICS: When Democrats attack!

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When Democrats attack, somehow it doesn’t convey the ferocity of the original series…but with Bush’s approval ratings going up as the price of gas comes down, the Democrats are issuing a Medicare drug report. Yup, they’ve noticed that there is both an election in November and that plenty of Part D participants are in the donut hole. And perhaps it’s about time to take the initiative back from the BS meme that “most people in Part D are happy so it must be a good thing/Republican votegetter, and the donut hole doesn’t really exist anyway.” The donut hole is the most obvious thing to go after, and the one that most seniors are concerned about, so here goes:

The analysis includes a breakdown by state showing how much more money residents would have to pay annually if they switched to a plan that had no doughnut hole. The nationwide average was $458. Residents of New Jersey would have to pay, on average, an additional $298. Residents of seven states would have to pay, on average, an additional $721. Those states are Iowa, Minnesota, Montana, North Dakota, Nebraska, South Dakota and Wyoming.”As this report shows, the opportunity to purchase plans that fill the hole is a mirage,” said Rep. Pete Stark, D-Calif. “Beneficiaries are no more able to afford expensive, full-coverage plans than minimum wage Americans are able to afford a Mercedes.”

On the other hand, they don’t seem to mention getting effective drug re-importation, even though that is banned by the legislation and over 80% of adults are in favor of it. And somehow they’ve managed to get the AP guys confused by the White House spin:

Democrats contend that one solution to filling the doughnut hole would be to let the government negotiate drug prices on behalf of beneficiaries, instead of having fragmented insurance companies doing that. Then, the government could use the savings achieved to do away with the gap. But Nelligan replied that all of the Democratic proposals that have been scored by the Congressional Budget Office had cost projections at least twice as high as the cost of the current drug benefit.

Hmm… it’s hard to imagine something costing more per benefit delivered than the current version of the Medicare Modernization Act, especially when the payoffs to employers, insurers and hospitals are counted in. And wasn’t there something about a certain government agency that already negotiates rather better on drug pricing that the Part D private plans, and yet somehow that information didn’t make it into this article? Oh yeah, there was.

POLITICS: McLellan–a man too soon?

The NY Times calls McLellan’s resignation the Departure of a Pragmatist. The basic problem was that his “reign” at FDA will be remembered for the pained look on his face when he was forced to defend the ban on reimportation on 60 Minutes, and the horlicks that was the introduction of Part D. He never looked too happy defending the stupid industry-based bills that the Congress sent him.

What he really wanted to do of course was turn Medicare into a real influential purchaser. There’s going to be a huge political fight about that, but it will happen eventually. And that’s a role for which he’ll be much better suited. Perhaps he’ll come back then?